| NPI | 1255033973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 143030) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: CA 844452) |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2023-05-31 |